Visiting Veterinarian

The race of his life

By Michele Gerhard Jasny V.M.D. - August 3, 2006

The Kentucky Derby - even people with little interest in horses feel the allure of the Run for The Roses. The hype, the mint juleps, the teary-eyed women in outlandish hats singing My Old Kentucky Home. And the horses - the biggest, fastest, most elegant thoroughbreds in the country. If you didn't make it to Louisville this year, you still probably heard about Barbaro, the three-year-old colt who won the Derby and had high hopes of winning the Triple Crown. (For them that don't know, that means winning three major races in a five-week period, the Kentucky Derby, Preakness, and Belmont Stakes, an athletic feat accomplished by only 11 horses in the last 125 years. The last Triple Crown winner was Affirmed in 1978.)

After a dramatic false start in which he came crashing out of the gate prematurely, Barbaro was uninjured, and reloaded into the gate. As the race began officially, Barbaro made it 130 meters down the track when his right hind leg suddenly gave out. His jockey did a masterful job of bringing Barbaro quickly and safely to a stop. My horse-crazy six-year-old daughter, Sydney, gasped from where we sat sipping Mint Magic Tea in front of the TV. "What happened, Mommy?" Sydney cried.

Within minutes, they began showing slow motion replays while waiting for word from the track veterinarians. I watched Barbaro's lower leg flail side to side, and although it's been years since I've done equine vetting, even a dog and cat vet like me could make that diagnosis. "I'm afraid Barbaro has broken his leg," I replied somberly.

"Can they fix him, Mommy?" she asked. "You fix broken legs all the time. They can fix him, right?"

"Well, it's a little different with a horse," I stammered. "But I'm sure they'll try."

Like a breaking board

Leg fractures in horses pose a particular set of challenges. To begin with, horses can be difficult to restrain, panicking easily and hurting themselves in the process. Next, horses need to be able to stand up. Although they can lie down for periods of rest, they cannot tolerate being recumbent for long stretches. Leg fractures must be repaired in a way that allows them to bear weight quickly. Finally, because horses depend on balancing their massive weight equally on four relatively small hooves, the other three legs are at serious risk of developing complications if the injured leg can't take its share of the stress in short order. Veterinarian Dr. Larry Bramlage put it this way on an NBC telecast. "If you had a similar fracture, it would be like saying to your orthopedist, "You have to put me together well enough so I can walk within hours, and I have to be able to put four to five men on my back. The healing has to take place in six weeks for me to survive. Otherwise, my other foot will fall off."

As Sydney and I waited for news, it took me back to 1975, watching the match race between Ruffian and Foolish Pleasure. It was a few years after Bobby Riggs had challenged Billy Jean King at tennis and the boy vs. girl thing was in vogue. The filly Ruffian had never been defeated. The colt Foolish Pleasure had won the Kentucky Derby that year. Foolish Pleasure broke from the gate ahead of Ruffian but she was rapidly gaining on him when both jockeys heard a sound they described "like the breaking of a board." Ruffian had broken her leg. Too excited to be stopped quickly, she kept running, exacerbating the damage. As soon as they could calm her, an inflatable cast was put on her leg and she was transported by ambulance to surgery. Four veterinarians and an orthopedic surgeon worked on her for 12 hours. She stopped breathing and was revived twice during the procedure. When the anesthesia wore off, she began thrashing wildly. Unable to be restrained, Ruffian broke the cast, and then broke the opposite leg in her panic. There was nothing to be done but to euthanize her and end her suffering.

What can a veterinarian on Martha's Vineyard do when faced with a seriously injured horse? Realistically, the first decision is economic. Barbaro and Ruffian both had huge potential value as breeding animals if they could be saved. They both had insurance policies. Veterinarian and horse owner together must look at the severity of the injury and make an informed decision. If the choice is for treatment, transport to an off-Island facility with equine specialists is usually the way to go. Island veterinarians can anesthetize animals with injectable medications for short periods of time, but we do not have access to the kind of equipment and expertise necessary for longer procedures.

Barbaro had a large team work on him at the University of Pennsylvania's New Bolton Center (my alma mater). I remember the intense activity involved when we were anesthetizing a horse there. The massive hydraulic surgery table, the special slings and lifts, the anesthesia machine designed especially for horses, the army of people, the swimming pool. That's right. A swimming pool. Barbaro's leg was pieced back together with 23 screws and a compression plate in a six-hour surgery, after which he was placed in a sling, still anesthetized, lifted with an electronic overhead winch, and transported along a monorail. His legs were encased in long waterproof sleeves and he was lowered into a giant raft in a pool where he was then allowed to awaken. Horses instinctively run when frightened, so they will try to stand and flee long before they should when coming out of surgery. In the recovery pool, horses can thrash around without injuring themselves.

Calm after the storm

Equine anesthesia in the field can be harder to control. When I was in college, I assisted a veterinarian who was removing a large facial tumor from a horse named Pinocchio. Doc had given intravenous drugs that dropped Pinnochio to the ground in a large paddock. The procedure went flawlessly. As the big bay began to awaken, he pulled himself to his feet, staggered a few steps, then fell down, smashing his face violently into the dirt. Doc held the end of a long lead rope, trying to control and calm the horse while keeping out of harm's way. After several such unsuccessful attempts to rise, Pinnochio flailed along the ground to the fence, flung his head under the lower rail, got stuck and proceeded to panic, slamming his neck repeatedly against the boards. We couldn't get near him and every moment the situation got more dire, as the boards cracked into lethal looking daggers. Doc yelled "Get an ax!" which one of the guys did, then proceeded to chop down the fence. Once freed, Pinnochio leapt to his feet, 1,500 pounds of agitated, sweaty, hyperventilating horse, and then stopped. Now that he had his feet under him and realized he was all right, he stood completely motionless, exhausted but unharmed.

Of course, veterinarians often anesthetize horses in the field without complications and many procedures can be done smoothly using tranquilizers that leave a horse sedated but standing. Pinocchio's case is simply one example of the unpredictable challenges equine anesthesia and surgery in the field can pose. For the best outcome, serious injuries and long procedures require high-tech facilities, a big support team, and someone like Barbaro's surgeon, Dr. Dean Richardson. He was my resident when I was a vet student at New Bolton Center. Now he's Chief of Surgery...and I have a daughter who gets up every morning and, after caring for her toy horses, says "I wonder how Barbaro is today." We go to www.vet.upenn.edu where Syd can check Barbaro's progress and Mommy can walk down memory lane.